Comparative efficacy of primary treatment approaches in anaplastic thyroid carcinoma (ATC): An updated network meta-analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18566-e18566
Author(s):  
Kevin M. Gallagher ◽  
Philip A. Haddad ◽  
Dalia A. Hammoud
Keyword(s):  
English Language ◽  
Meta Analysis ◽  
Survival Rates ◽  
Primary Treatment ◽  
Anaplastic Thyroid Carcinoma ◽  
Treatment Modalities ◽  
Therapeutic Modalities ◽  
Online Databases ◽  
Significant Survival ◽  
Inconsistency Analysis

e18566 Background: ATC is a rare tumor accounting for around 5% of all thyroid cancers. With survival measured in months, ATC is often fatal despite combined therapeutic approaches. Several studies reported on ATC treatment modalities indicating different outcomes and occasionally conflicting results. This analysis was conducted to update and expand our existing knowledge of the relative efficacy of the available therapeutic modalities in this rare disease. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of (i) English language, (ii) diagnosis of ATC, (iii) treatment with complete resection (SX), radiotherapy (RT), surgery and radiotherapy (SRT), chemoradiotherapy (CRT), and combined surgery, radiation, and chemotherapy (COMB), and (iv) comparative studies reporting survival rates. A frequentists network meta-analysis was conducted using netmeta package and random-effects model. Results: Six studies comprising a total of 476 participants were included. SX, RT, CRT, SRT, and COMB approaches demonstrated significant survival advantage over no treatment and/or palliative care. Using odds ratio for analysis, COMB ranked highest followed by SRT, SX, CRT, and RT in a decreasing order. Inconsistency analysis did not reveal any significant differences between direct and indirect estimates. Conclusions: This network meta-analysis is the first to compare and rank commonly used treatment modalities in ATC. It indicates that SX and RT remain the backbone for any treatment approach that significantly impacts survival in ATC.

scholarly journals Intangible assets in the process of internationalization

2020 ◽  
Vol 56 (1) ◽  
pp. 63-78
Author(s):  
Łukasz Bryl
Keyword(s):  
English Language ◽  
Intangible Assets ◽  
Meta Analysis ◽  
Strong Relationship ◽  
Valuable Insight ◽  
Internationalization Process ◽  
Journal Articles ◽  
Employee Education ◽  
Current State ◽  
Online Databases

AbstractThe aim of this article is to determine the current state of impact of various forms of intangible assets on the internationalization process. For the purpose of the paper meta-analysis was adopted as a method of the study. English-language peer-reviewed journal articles were analyzed only with the help of: EBSCOhost, ScienceDirect, Emerald, JSTOR, ProQuest and Wiley Online databases. The search was aimed at newest papers (after 2012), however some older articles (with regard to their value) were included in the analysis as well. Based on the conducted analysis, there was observed a significant and positive link between the level of employee education and internationalization probability and extent. The effect of the wages on internationalization is stage dependent. Under certain assumptions there is a positive and strong relationship between R&D intensity and internationalization. Advertising spending do not foster the process of internationalization. The practical contribution of this research is twofold. First, it provides valuable insight for practitioners which intangible assets and how foster various modes of the internationalization process. Second, it describes upon which conditions the interrelation between firm intangible assets and internationalization is significant and positive.

scholarly journals Intralesional cryotherapy for hypertrophic scars and keloids: a review

2017 ◽  
Vol 3 ◽  
pp. 205951311770216 ◽  
Author(s):  
Ciaran P O’Boyle ◽  
Holleh Shayan-Arani ◽  
Maha Wagdy Hamada
Keyword(s):  
English Language ◽  
Meta Analysis ◽  
Case Series ◽  
Evidence Base ◽  
Treatment Modalities ◽  
Hypertrophic Scars ◽  
Published Evidence ◽  
Keloid Scarring ◽  
Comparative Trials ◽  
Scar Reduction

Introduction: Hypertrophic and keloid scarring remain notoriously troublesome for patients to tolerate and frustratingly difficult for clinicians to treat. Many different treatment modalities exist, signifying the failure of any method to achieve consistently excellent results. Intralesional cryotherapy is a relatively recent development that uses a double lumen needle, placed through the core of a keloid or hypertrophic scar, to deliver nitrogen vapour, which freezes the scar from its core, outwards. Methods: This article provides a comprehensive review of the literature on intralesional cryotherapy for hypertrophic scars and keloids. A systematic review or meta-analysis was not possible, since the existing articles did not permit this. Results: A search of English language, peer-reviewed literature was carried out. The evidence base was found to be low (level 4). In addition, much of the published evidence comes from a very few groups. Despite this, consistent findings from case series suggest that the technique is safe and achieves good scar reduction with very few treatments. Adverse effects include depigmentation, recurrence and pain. Pain and recurrence appear to be uncommon and depigmentation may be temporary. Discussion: Well-constructed, prospectively recruited comparative trials are absent from the literature. These are strongly encouraged, in order to strengthen general confidence in this technique and in the repeatability of outcomes reported thus far.

scholarly journals Comparison of Treatment Modalities in Frontline Therapy of Stages I/IE Extranodal NK/T-Cell Lymphoma-Nasal Type (ENKTL-N): An up-to-Date Network Meta-Analysis

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4538-4538
Author(s):  
Philip A Haddad ◽  
Dalia Hammoud ◽  
Kevin M. Gallagher
Keyword(s):  
Comparative Studies ◽  
English Language ◽  
Conflicts Of Interest ◽  
Early Stage ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Disease Free Survival ◽  
Stage I ◽  
Treatment Modalities ◽  
Direct Head

Abstract Introduction: Despite many studies reporting on the optimal therapies for early stage ENKTL-N in the front-line setting, this area continues to be subject to a significant controversy regarding single modalities versus combination or sequential approaches. All these comparative studies were small non-randomized studies that combined stages I & II. The results were often inconclusive and occasionally conflicting. In the absence of direct head-to-head randomized controlled trials in this clinical setting, a network meta-analysis was conducted to compare these therapeutic approaches and their respective impact on 5-year survival in stage I/IE ENKTL-N. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of English language, diagnosis of stage I/IE ENKTL-N, treatment with chemotherapy (CT), radiation (RT), sequential CT and RT (SEQ), and chemoradiotherapy (CRT), comparative studies that reported predominantly (>70%) I/IE 5-year overall survival (OS) and disease-free survival (DFS) rates. Studies that reported on mixed samples of early and advanced ENKTL were excluded. A frequentist network meta-analysis was conducted using the netmeta package and random-effects model. Results: Seven studies comprising a total of 397 participants were included. Our network meta-analysis revealed that upfront RT tended to have better 5-year OS and DFS than CRT, SEQ, though it did not reach statistical significance. However, RT had a significantly superior 5-year OS when compared to CT (RR=0.43, 0.19-0.97). Based on the pair-wise and network meta-analyses, RT was ranked as the most effective first-line treatment approach followed by CRT, SEQ, and CT in decreasing order. Analysis of the 5-year DFS yielded similar findings. Inconsistency analysis did not reveal any significant differences between direct and indirect estimates. Conclusion: This is the first network meta-analysis to compare all commonly utilized upfront treatment modalities in stages I/IE ENKTL-N. It indicates that upfront RT alone may be sufficient as there was no signal that chemotherapy added any OS or DFS advantages. Adequately powered randomized trials are warranted. Disclosures No relevant conflicts of interest to declare.

scholarly journals The Impact of Chromothripsis on the Clinical Outcomes of Acute Myeloid Leukemia (AML): A Meta-Analysis

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 34-34
Author(s):  
Philip A Haddad ◽  
Dalia Hammoud ◽  
Kevin M. Gallagher
Keyword(s):  
Clinical Outcomes ◽  
English Language ◽  
Conflicts Of Interest ◽  
Meta Analysis ◽  
Response Rates ◽  
Kaplan Meier ◽  
Online Databases ◽  
Inverse Variance ◽  
Aggressive Clinical Course ◽  
The Impact

Introduction: Chromothripsis is a single genomic catastrophic event that can involve one or several chromosomes resulting in chromosomal fragmentation. Genomic instability leading to loss of chromosomes and complex karyotype is known to be associated with resistance to chemotherapy and poor prognosis in AML. While chromothripsis is associated with aggressive clinical course in various cancers, its impact on AML clinical outcomes has not been consistently conclusive. The purpose of this meta-analysis is to evaluate the pooled effect of chromothripsis on the response rates and overall survival of patients with AML. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of AML diagnosis, English language, and studies reporting OS with hazard ratios (HR) or Kaplan-Meier curves that compared AML outcomes with and without chromothripsis. A meta-analysis using an inverse variance method with a random-effects model was conducted. Results: Two comparative studies with a total of 444 patients were included in this meta-analysis. In the presence of chromothripsis OS was adversely impacted (HR 1.78, 95%CI: 1.05-3.01, p=0.03) with a heterogeneity estimate, I2=40%. Moreover, response rates were significantly lower in AML cases with chromothripsis versus those without (19% vs. 62%, p<0.05). Conclusions: This meta-analysis confirms the adverse impact of chromothripsis on response rates and OS of patients with AML. Disclosures No relevant conflicts of interest to declare.

Comparative efficacy of commonly used first-line chemotherapy regimens in advanced pancreatic cancer: A network meta-analysis.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 403-403
Author(s):  
Philip A. Haddad ◽  
Kevin Michael Gallagher ◽  
Dalia Hammoud
Keyword(s):  
Pancreatic Cancer ◽  
English Language ◽  
Meta Analysis ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Response Rates ◽  
The United States ◽  
First Line ◽  
Treatment Regimens ◽  
Inconsistency Analysis

403 Background: Pancreatic adenocarcinoma is one of the deadliest cancers, ranking fourth in mortality and accounting for up to 7% of all cancer related deaths in the United States. For many years, Gemcitabine and its combinations have been the standard first-line treatments for patients with unresectable locally advanced or metastatic pancreatic cancer (aPC). Recently, FOLFIRINOX was shown to be associated with a survival advantage as well. These chemotherapy combinations have not been compared to each other. We conducted this network meta-analysis to evaluate the relative efficacy of the commonly used chemotherapy regimens in patients with aPC. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of English language; diagnosis of aPC; treatment with Gemcitabine (GEM) combined with Capecitabine (CAPE), Erlotinib (ERLO), or nab-Paclitaxel (NABPAC) and treatments with FOLFIRINOX; and randomized studies reporting survival and response rates. A frequentists network meta-analysis was conducted using netmeta package and random-effects model. Results: Six studies comprising a total of 2,717 participants were included. FOLFIRINOX demonstrated a significantly better relative risk (RR) of progression and death (P&D) followed by GEM+NABPAC, GEM+ERLO, GEM+CAPE, and GEM in a decreasing order. When compared to GEM-based combination as a group, FOLFIRINOX maintained its superior RR for P&D. Moreover, FOLFIRINOX and GEM+NABPAC had significantly better response rates than GEM+CAPE and GEM+ERLO. Inconsistency analysis did not reveal any significant differences between direct and indirect estimates. Conclusions: This network meta-analysis is the first to compare and rank commonly used treatment regimens in aPC. It indicates that FOLFIRINOX combination seems to be superior to GEM-based combinations with respect to P&D as well as response rates. Nevertheless, among GEM-based combinations, GEM+NABPAC seems to have the best profile given its lower RR for P&D and higher response rates.

A meta-analysis of tumor control rates and treatment-related morbidity for patients with glomus jugulare tumors

2011 ◽  
Vol 114 (5) ◽  
pp. 1299-1305 ◽  
Author(s):  
Michael E. Ivan ◽  
Michael E. Sughrue ◽  
Aaron J. Clark ◽  
Ari J. Kane ◽  
Derick Aranda ◽  
...  
Keyword(s):  
English Language ◽  
Meta Analysis ◽  
Treatment Modalities ◽  
Cranial Neuropathy ◽  
Tumor Control ◽  
Subtotal Resection ◽  
Diverse Range ◽  
Tumor Control Rate ◽  
Glomus Jugulare

Object Because of the rarity of glomus jugulare tumors, a variety of treatment paradigms are currently used. There is no consensus regarding the optimal management to control tumor burden while minimizing treatment-related morbidity. In this study, the authors assessed data collected from 869 patients with glomus jugulare tumors from the published literature to identify treatment variables that impacted clinical outcomes and tumor control rates. Methods A comprehensive search of the English-language literature identified 109 studies that collectively described outcomes for patients with glomus jugulare tumors. Univariate comparisons of demographic information between treatment cohorts were performed to detect differences in the sex distribution, age, and Fisch class of tumors among various treatment modalities. Meta-analyses were performed on calculated rates of recurrence and cranial neuropathy after subtotal resection (STR), gross-total resection (GTR), STR with adjuvant postoperative radiosurgery (STR+SRS), and stereotactic radiosurgery alone (SRS). Results The authors identified 869 patients who met their inclusion criteria. In these studies, the length of follow-up ranged from 6 to 256 months. Patients treated with STR were observed for 72 ± 7.9 months and had a tumor control rate of 69% (95% CI 57%–82%). Those who underwent GTR had a follow-up of 88 ± 5.0 months and a tumor control rate of 86% (95% CI 81%–91%). Those treated with STR+SRS were observed for 96 ± 4.4 months and had a tumor control rate of 71% (95% CI 53%–83%). Patients undergoing SRS alone had a follow-up of 71 ± 4.9 months and a tumor control rate of 95% (95% CI 92%–99%). The authors' analysis found that patients undergoing SRS had the lowest rates of recurrence of these 4 cohorts, and therefore, these patients experienced the most favorable rates of tumor control (p < 0.01). Patients who underwent GTR sustained worse rates of cranial nerve (CN) deficits with regard to CNs IX–XI than those who underwent SRS alone; however, the rates of CN XII deficits were comparable. Conclusions The authors' analysis is limited by the quality and accuracy of these studies and may reflect source study biases, as it is impossible to control for the quality of the data reported in the literature. Finally, due to the diverse range of data presentation, the authors found that they were limited in their ability to study and control for certain variables. Some of these limitations should be minimized with their use of meta-analysis methods, which statistically evaluate and adjust for between-study heterogeneity. These results provide the impetus to initiate a prospective study, appropriately controlling for variables that can confound the retrospective analyses that largely comprise the existing literature.

scholarly journals The assessment of Ki-67 as a prognostic marker in neuroendocrine tumours: a systematic review and meta-analysis

2015 ◽  
Vol 69 (7) ◽  
pp. 612-618 ◽  
Author(s):  
Sebastian Richards-Taylor ◽  
Sean M Ewings ◽  
Eleanor Jaynes ◽  
Charles Tilley ◽  
Sarah G Ellis ◽  
...  
Keyword(s):  
English Language ◽  
Neuroendocrine Tumours ◽  
Meta Analysis ◽  
Survival Rates ◽  
Combine Data ◽  
Exclusion Criteria ◽  
Ki 67 ◽  
M 10 ◽  
M 12 ◽  
Gastroenteropancreatic Neuroendocrine Tumours

IntroductionGastroenteropancreatic neuroendocrine tumours (GEP NETs) are classified according to tumour mitotic count or Ki-67 labelling index (LI).Aim(s)To systematically review articles reporting the prognosis of patients by Ki-67 LI and thereby improve the ability of clinicians to prognosticate for their patients.Method265 abstracts were identified relating Ki-67 and survival. After exclusion criteria were applied, 22 articles remained. Articles were excluded if they described non-human specimens, were non-English language, published prior to 2000, reported non-GEP NETs, reported subgroups selected by treatment modality or included <20 cases. Random-effects meta-analysis was used to combine studies to estimate survival proportions.ResultsAuthors used varied methods in which to present 5-year survival, with often limited survival information. This reduced the number of studies that could be included in the meta-analysis. 5-year survival for patients with grade 1 and 2 GEP NETs were estimated to be 89% (95% CI 85% to 92%, m=12 studies, n=977 participants) and 70% (95% CI 62% to 79%, m=9, n=726), respectively. Using an alternative grade 1/2 boundary of 5%, 5-year survival rates for Ki-67≤5% and 5–20% were estimated as 89% (95% CI 84% to 94%, m=7, n=654) and 51% (95% CI 44% to 59%, m=4, n=183), respectively. For Ki-67>20%, 5-year survival was estimated to be 25% (95% CI 12% to 38%, m=10, n=208).ConclusionsStandardisation of grade boundaries has allowed us to combine data from multiple studies and amass a body of evidence linking Ki-67 and survival.

Surgical Management of Craniopharyngiomas in Children: Meta-analysis and Comparison of Transcranial and Transsphenoidal Approaches

Neurosurgery ◽  
2011 ◽  
Vol 69 (3) ◽  
pp. 630-643 ◽  
Author(s):  
Robert E Elliott ◽  
John A Jane ◽  
Jeffrey H Wisoff
Keyword(s):  
English Language ◽  
Meta Analysis ◽  
Outcome Data ◽  
Inclusion Criteria ◽  
Lateral Extension ◽  
Increased Intracranial Pressure ◽  
Online Databases ◽  
Neurological Morbidity ◽  
Vascular Structures ◽  
Lower Morbidity

Abstract BACKGROUND: Controversy persists regarding the optimal treatment of pediatric craniopharyngiomas. OBJECTIVE: We performed a meta-analysis of reported series of transcranial (TC) and transsphenoidal (TS) surgery for pediatric craniopharyngiomas to determine whether comparisons between the outcomes in TS and TC approaches are valid. METHODS: Online databases were searched for English-language articles reporting quantifiable outcome data published between 1990 and 2010 pertaining to the surgical treatment of pediatric craniopharyngiomas. Forty-eight studies describing 2955 patients having TC surgery and 13 studies describing 373 patients having TS surgery met inclusion criteria. RESULTS: Before surgery, patients who had TC surgery had less visual loss, more frequent hydrocephalus and increased intracranial pressure, larger tumors, and more suprasellar disease. After surgery, patients in the TC group had lower rates of gross total resection (GTR), more frequent recurrence after GTR, higher neurological morbidity, more frequent diabetes insipidus, less improvement, and greater deterioration in vision. There was no difference in operative mortality, obesity/hyperphagia, or overall survival percentages. CONCLUSION: Directly comparing outcomes after TC and TS surgery for pediatric craniopharyngiomas does not appear to be valid. Baseline differences in patients who underwent each approach create selection bias that may explain the improved rates of disease control and lower morbidity of TS resection. Although TS approaches are becoming increasingly used for smaller tumors and those primarily intrasellar, tumors more amenable to TC surgery include large tumors with significant lateral extension, those that engulf vascular structures, and those with significant peripheral calcification.

scholarly journals 22. COMPARATIVE EFFICACY OF ALK-INHIBITORS IN ALK INHIBITOR-NAIVE ALK+ LUNG CANCER BRAIN METASTASES: A NETWORK META-ANALYSIS

2020 ◽  
Vol 2 (Supplement_2) ◽  
pp. ii3-ii4
Author(s):  
Philip Haddad ◽  
Dalia Hammoud ◽  
Kevin Gallagher
Keyword(s):  
Lung Cancer ◽  
Brain Metastases ◽  
Comparative Studies ◽  
English Language ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Alk Inhibitors ◽  
Molecular Abnormalities ◽  
Online Databases ◽  
Previously Treated

Abstract BACKGROUND Lung cancer has been the leading cause of cancer death for both men and women worldwide. Non-small-cell lung cancer (NSCLC) displays an array of molecular abnormalities most commonly involving ALK and EGFR pathways. NSCLC with ALK rearrangements comprises around 5% of cases. Over the years, several ALK inhibitors (ALKI) have been approved with notable activity in brain metastases. However, there have been limited comparative studies exploring their relative efficacies. This analysis was conducted to compare the relative efficacy of ALKIs against ALKI-naïve ALK+ lung cancer brain metastases. METHODOLOGY A review of the medical literature was conducted using online databases. Inclusion criteria consisted of English language; diagnosis of ALKI-naïve ALK+ lung cancer trials with brain metastases; treatment with Crizotinib (CRZ), Alectinib (ALC), Brigatinib (BRG), and Ceritinib (CER); and comparative studies reporting brain metastases specific responses/events. A Bayesian and a frequentists network meta-analysis were conducted using netmeta package and the random-effects model. RESULTS Eight studies comprising a total of 665 participants with ALKI-naive ALK+ lung cancer brain metastases were included. When compared pair-wise to CRZ, ALC (RR=0.49;95%CI:0.36–0.66), BRG (RR=0.39;95%CI:0.24–0.64), and CER (RR=0.36;95%CI:0.19–0.68) demonstrated significantly superior response rates in patients with untreated or previously treated lung cancer brain metastases. When the efficacy of each ALKI was compared to each other, BRG and CER were ranked the highest followed by ALC then CRZ in decreasing order. CONCLUSIONS This network meta-analysis is the first to compare and rank ALKIs used in treating metastatic ALK+ lung cancer. It indicates that BRG, CER, and ALC are better therapeutic options for patients with ALK-naive ALK+ lung cancer brain metastases when compared to CRZ.

scholarly journals Management of Graves’ Hyperthyroidism: More Than a Century of Progression

2020 ◽  
Vol 18 (Suppl) ◽  
Author(s):  
Hengameh Abdi ◽  
Atieh Amouzegar
Keyword(s):  
English Language ◽  
Treatment Strategies ◽  
Primary Treatment ◽  
Therapeutic Modality ◽  
Antithyroid Drugs ◽  
Efficacy And Safety ◽  
Therapeutic Modalities ◽  
Advantages And Disadvantages ◽  
History Of

Context: There are three therapeutic modalities for the management of Graves’ disease (GD), including thyroid surgery, radioactive iodine (RAI), and antithyroid drugs (ATDs). We aimed to briefly review the history of these treatment strategies and their advantages and disadvantages. Evidence Acquisition: We searched PubMed for English language articles using pertinent search terms. Results: Each treatment modality for GD is accompanied by several advantages and disadvantages. Nowadays, ATDs are the most commonly prescribed therapy for GD worldwide. The lack of well-designed, large RCTs comparing three different treatments for hyperthyroidism concerning various short-term and long-term outcomes has led to remarkable uncertainty in the preference of each of these treatments, as is evident in relevant guidelines from different societies. Recently, the efficacy and safety of long-term use of ATDs have been documented. Conclusions: Pros and cons of each therapeutic modality for Graves’ hyperthyroidism should be taken into account during the physician-patient discussion to select the primary treatment. Considering recent data about the long-term efficacy and safety of ATDs, it seems that the appropriate selection of Graves’ patients for long-term ATD therapy can be a new avenue in the treatment and even cure of GD.

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